Commentary: Office Visit: Treatments - at What Cost?

Commentary: Office Visit: Treatments - at What Cost?

Article excerpt

Health care access and affordability are topics receiving much
attention locally and nationally. In focusing on affordable health
care, one of the critical factors to be considered is what medical
treatments are covered under a health care benefit plan. In my
opinion health care plans should provide benefits for certain
medical treatments that are within the established standard of care
and supported by peer-reviewed medical literature.

Covered treatments are generally those proven to be effective by
medical and scientific evidence. An experimental treatment is one in
which the results, as well as the risks to the patient, are unknown.
Many times an experimental treatment has never been tested on a
human. An investigational treatment is one for which experimental
trials have been conducted and patient safety has been determined;
however, research studies lack evidence of the beneficial effects.

Experimental and investigational treatments can be very
expensive. As health care costs rapidly increase, employers,
consumers, health care providers and insurers struggle with the
rising costs and the impact on the uninsured. With that in mind,
consumers' health care dollars must be spent prudently on medical
treatments that are proven effective and that demonstrate improved
health outcomes. For health plans to have adequate resources to
provide benefits for covered medical treatments that are the
standard of care and supported by medical evidence of effectiveness,
health plan dollars should not be spent to cover experimental and
investigational treatments.

If health care plans covered experimental or investigational
treatments, health premiums would increase. Since employers purchase
the majority of insurance coverage in Oklahoma, they would be forced
to pay those additional costs. As a result, employers might limit
benefits, pass the additional costs to employees, or eliminate
insurance plans for employees, adding to the number of uninsured
Oklahomans. Mandating coverage of certain treatments that are costly
would increase the burden on small employers who purchase insurance
policies. Many large employers have self-funded health care plans
that are exempt from state-mandated benefits.

Patients sometimes are compelled to seek any kind of treatment
out of desperation - even if there's no evidence that the treatment
works. …